Discussed August 17th, 2006 - VP 2-21.

Predictors of hemorrhage following laparoscopic partial nephrectomy (LPN). M. C. Ost, S. Montag, S. Permpongkosol, A. R. Rastinehad, and L. R. Kavoussi. North Shore-Long Island Jewish Medical Center, New Hyde Park, New York, U.S.A.

In this report, the overall blood transfusion rate was 7% among 335 patients undergoing laparoscopic partial nephrectomy. The only risk factor that distinguished between the two groups was renal insufficiency (8.7% vs. 1.9% for patients with normal renal function) (p=.03). Hypertension, obesity, diabetes, and smoking history were not significant factors. When transfusion was required, operative time and hospital stay became statistically significantly longer. The reader is cautioned to some extent as this study encompasses a 12 year experience with laparoscopic partial nephrectomy during which time, the authors’ technique has certainly evolved and improved. While much controversy exists as to the “best” way to perform this procedure, from cutting cold to cutting “hot”, clamping artery and vein or just artery, use of Floseal or tissue glue, use of argon beam coagulator, closing or leaving the collecting system open, placement of simple or mattress sutures over bolsters, tying knots or using LaparaTy clips, I would submit that, especially for those embarking on this most challenging laparoscopic procedure, you can never have “too” much hemostasis.

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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